This summer a bipartisan bill called the South Asian Heart Health Awareness and Research Act of 2017 (H.R. 3592) addressing the higher prevalence of heart disease in this population was introduced in the U.S. House of Representatives by Rep. Pramila Jayapal (D-WA) and co-sponsored by 18 other House members, including Rep. Joe Wilson (R-SC).

An Early Career (EC) professional, Sandeep Krishnan, MD, and a Fellow in Training (FIT), Jill M. Steiner, MD, were crucial to the introduction of this bill.

In this interview, Hussein Abu Daya, MD, chair of the ACC FIT Council Advocacy Workgroup, talked with Krishnan and Steiner about their experience with advocacy and what’s involved with becoming an advocate.

Abu Daya: Sandeep, what was your journey to becoming an advocate?

Krishnan: My interest in advocacy dates to my medical school days. Through my involvement with the American Medical Association, I served on the National Resident Matching Program on the Board of Directors. And I worked on Capitol Hill during medical school as a congressional health policy intern in my congressman’s office.

During my first two years of cardiology fellowship, I got involved with ACC and in 2014 attended my first ACC Legislative Conference. Through the mentorship of Norman Lepor, MD, FACC, I became close with Rep. Ted Lieu (D-CA). Lepor was the former governor of the ACC California Chapter and he fostered this relationship and helped to shape my interest in health policy.

I was then given the opportunity to be a part of the Emerging Advocates and Leadership Academy programs, thanks to my mentor, John Gordon Harold, MD, MACC, former ACC president.

For my fellowship in interventional cardiology, I moved to Seattle, where I was elected to be the ACC Advocacy Chair for the Washington Chapter. I helped to reinvigorate our state Lobby Day under the leadership of our ACC Chapter President, Eugene Yang, MD, FACC. I also had the good blessing of meeting Jayapal at the 2016 ACC Legislative Conference and from there our relationship has blossomed.

Sandeep, you were involved in the initiation of this bill and worked closely with Jayapal. What was your involvement and what was the process?

Krishnan: After meeting Jayapal and realizing we shared a passion for improving cardiovascular health, especially in the South Asian population which is at higher risk for heart disease, I met more of her office staff both locally and nationally.

I sponsored two site visits, one with her director of Outreach and one with her, at the cath lab at the University of Washington so they could see the work we do every day to treat heart disease. Because of this and our mutual interests, Jayapal invited me to participate in the U.S. Congressional Legislative Briefing on this Bill to help introduce it in the House of Representatives.

Jill, you were on the panel before the House of Representatives to support this bill. What was your involvement with the Bill and your experience on Capitol Hill?

Steiner: I’ve participated in a couple of advocacy-related events. One was a visit to our state capitol with the ACC Washington Chapter. Sandeep coordinated this event, during which we had the opportunity to discuss a number of measures with legislators.

A few months later, we learned Jayapal would introduce H.R. 3592 and we were asked to participate in a panel discussion. As a cardiologist, I was asked to moderate the panel, which included a neurologist and an internist representing the American Association of Physicians of Indian Origin (AAPI).

I met with ACC advocacy staff and associates of Jayapal before the session. We prepared a fact sheet for distribution with information about the disproportionate burden of cardiovascular disease in the South Asian population, contributing risk factors and health conditions, and how the actions proposed by H.R. 3592 would address these concerns.

We began with a summary of population-specific heart disease statistics, and then held an open discussion with those attending the briefing. We and many of the AAPI members shared personal anecdotes and discussed ways to improve the health of our patients. One major theme was the importance of culturally-appropriate materials and programs that would resonate with the target audience, particularly regarding nutrition, health literacy and breaking down some of the stigma around diabetes and heart disease.

This was a great opportunity to raise awareness for the bill and gain perspectives from the community of clinicians who work every day to support this population. By the end of the session, everyone had a better understanding of this important issue, and the bill seemed to have a great deal of support.

Jill, do you continue to work with your state legislators on other advocacy matters?

Steiner: Yes. Following the briefing, I had the opportunity to attend a local event supporting Jayapal. At that event, we discussed the briefing and other legislation she anticipates moving forward in the coming year. I look forward to the opportunity to meet with her again and to participate in other advocacy events with our local ACC Chapter.

How important is it for FITs and ECs to be involved in advocacy on a state/chapter level? How can get they can started?

Steiner: There is always a place for FITs and ECs to be involved in advocacy, especially with support from organizations like the ACC. Those on the political side of this relationship want to talk with us on the clinical side, both to inform their work and to maintain strong bonds with their districts and constituents.

We should engage to maintain active roles in our community’s legislative practices. No one knows the needs of our patients and health care systems better than we who serve them. We can voice these needs to the people in positions to improve conditions at the state level or higher.

FITs or ECs interested in advocacy activities should reach out to their local ACC Chapter or similar organization to start the conversation to get involved. Opportunities for impact exist. We must be willing to engage. Say yes to all opportunities and see where they take you! We can do a lot of good outside the walls of our hospitals.

Krishnan: It’s vital that we all play a role in advocacy both at the state and the federal levels. There’s always more interest to be involved at the federal level, but there’s often much less movement in the U.S. House and Senate than at the state level. Surprisingly, things can move quite quickly at the state level. And, with the proper connections and coalitions, anyone can make a big difference at the state level.

This realization spurred me to reinvigorate the ACC Washington State Chapter Legislative Day we called “Cardiology at the Capitol” in February 2018. We had a successful, well-attended event with a diverse group of attendees, including several members of the Cardiovascular Team. We spoke with the legislators about prior authorization reform at the state level and shared patient stories of how prior authorization struggles negatively impact their care and hurt them in some cases.

The bar to getting involved at the state and local levels is quite low and the ability to have a big impact is high. As the adage goes, “All politics are local.” This rings true now just as it did in the earliest times of our democracy.

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Don’t miss our roundup of recent successes through grassroots, state-driven advocacy.

Keywords: ACC Publications, Cardiology Magazine, Fellowships and Scholarships, Heart Diseases

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